Abstract
Objectives: This retrospective single-center study aimed to investigate the risk factors, outcomes and complication rates in patients older vs. younger than 80 years treated with intravenous alteplase.Methods: Data of 1,253 thrombolysed patients were analyzed between January 1, 2004 and August 31, 2016. Vascular risk factors, stroke severity based on the NIHSS score, functional outcome using modified Rankin Scale (mRS), mortality and symptomatic intracerebral hemorrhage (SICH) were compared between two subgroups (<80 and ≥80 years).Results: 1,125 patients were included, 199 (17.6%) among them were aged over 80 years, majority (63.3%) were female (p < 0.00001). Mean age was 68.2 ± 12.4 years, i.e., 64.7 ± 10.8 years and 84.3 ± 3.4 years in the younger and the older groups, respectively (p < 0.001). Atrial fibrillation and pre-stroke anticoagulation among patients over 80 years was more likely (p < 0.0005 and p = 0.02, respectively). NIHSS scores on admission and at 24 h were higher in elderly patients (p < 0.0001). ASPECT score at 24 h was less favorable in elderly patients (p = 0.007) and was associated with worse outcome. At 3 months, 59.8% of the patients from the older group had an unfavorable outcome (p < 0.0001), however 34.7% had independent outcome. The one-year- survival was significantly worse in the older group (p < 0.0001). The incidence of SICH was lower among older patients. In a logistic regression model, atrial fibrillation, heart failure, diabetes mellitus and smoking were proven as a significant independent risk factors for worse outcome.Conclusion: Although, the outcomes were less favorable in patients over 80 years of age, our results support the feasibility of using intravenous thrombolysis among patients over 80 years of age.
Highlights
Stroke is the second most common cause of death and a major cause of disability worldwide [1]
Consistent with previous studies [25,26,27,28], our findings showed that hypertension was the most important risk factor in both subgroups, and it was more prevalent in older patients
Atrial fibrillation is associated with a five-fold increase in the risk for ischemic stroke, but anticoagulant therapy may reduce the risk of recurrent stroke by ∼by 60% [31, 32]
Summary
Stroke is the second most common cause of death and a major cause of disability worldwide [1]. In the first major IV-rtPA study, the NINDS trial, treatment of ischaemic stroke with alteplase was not investigated in patients aged over 80, and in further studies, like ECASS-II, this population was excluded. This age restriction came from the potential higher risk of cerebral bleeding and caused uncertainty about the risk-benefit profile in these patients [5]. Earlier studies seem to show that high age is an independent predictor of symptomatic intracerebral hemorrhage (SICH) in patients treated with IV-rtPA and the incidence of SICH increases with age [3, 6]. The conclusion of all these studies is that age alone should not be the reason to exclude patients from treatment with IV-rtPA
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